When starting a stimulant, we often try Focalin XR as a 1st choice (generic name is dexmethylphenidate ER) which is FDA approved for ADHD in kids 6 and older. This XR, or extended relief version, usually lasts 8-12 hours, so needs to be taken in the AM with or after breakfast (so we don't have too much weight loss, as these meds impair appetite).
It works, as do all stimulants, by limiting the reuptake of norepinephrine and dopamine in the prefrontal cortex, which allows this region of the brain to work more effectively. This region of the brain is responsible for impulse control, focus, and decision making (executive function tasks).
It's dosing range is between 5mg and 40mg per day, once per day.
I usually start at 5mg on day 1, which will likely be too low. On day 2, if there were no issues on day 1, we would try 2 capsules, or 10mg in the AM. Try that for 2-3 days and let me know how it's going. If it's working well without issues, we will stay there. But most have to get to higher doses.
One of the other nice things about Focalin XR is that for those who have trouble swallowing capsules, you can open up the capsule to dump out the beads onto apple sauce, yogurt, or peanut butter. Don't put it in liquid though because you'll lose a lot of it as it sticks to the glass.
Here is more information on what to watch for when taking stimulants:
**If there is a history of cardiac problems such as sudden cardiac death or arrhythmias in the immediate family (parents, siblings), please get an EKG prior to starting stimulants. Stimulants are thought to be safe on the heart but, like drinking high amounts of caffeine, stimulants can be problematic for people who have a family history of severe cardiac issues.
Stimulants are the most commonly prescribed treatment for ADHD & impulse control disorders. The reason for this is that they are SO effective and they tend to be reasonably well tolerated. That said, they have side effects to watch for. Here are the big 5 that we really want to watch for, followed by other issues to consider in general:
-Appetite suppression (with weight loss eventually)
-Irritability (either when on the med or, more likely, when it wears off)
-Anxiety while on the medication (just as caffeine makes some people more anxious)
-Tics -- motor and/or verbal tics, which tend to be more of an issue in boys under the age of 10
The other issues for all stimulants are
Posted by David Danish MD